commentaries on prilleltensky and nelson

HEATHER HUNT* and GILL CROW

Community under 7s, The Space, Library, She�eld, UK

We welcomed the opportunity to appraise and comment on Prilleltensky andNelson's article from the perspective of Health Service community psychologists inthe UK. We are currently working on a three-year project aiming to develop innova-tive ways to prevent emotional and behavioural problems in young children inShe�eld. The project is funded by the NHS Community Trust and based in inner-citycommunities which have su�ered from the collapse of heavy industry over the lastdecade with resulting high rates of socio-economic deprivation. The paper by Prillel-tensky and Nelson was therefore of great interest to us as a potential tool forconceptualizing our work and contributing to understanding within di�erent agenciesof the multifactorial nature of children's well-being.

We endorse the need for a holistic and political framework to address family well-being which does not victimize the poor and wholeheartedly share the authors'advocacy of the fundamental shift in social priorities to address poverty. We appre-ciated the summary of the data regarding the incidence of emotional and behaviourdisorders and the concise argument for taking an ecological approach to promotingfamily wellness.We are commenting at the time in British politics when child poverty isagain being highlighted. Twenty-®ve per cent of British children grow up in povertyÐhigher rates than in Greece or Portugal. The case for redressing inequalities isessentially made in the thorough epidemiological work of Richard Wilkinson (1996).The accumulative evidence is that it is the extent of the gap between rich and poor inany society that determines levels of crime, physical and emotional health andcommunity cohesionÐthe factors this paper emphasizes contribute to family wellness.The divides in theUKhave increased over the last 18 years, and in that light the currentgovernment's focus on reducing child poverty and increasing childcare with theWorking Families Tax Credit, and increasing nursery provision for three- and four-year-olds, is a welcome shift in social policy and consistent with the social policiesadvocated by Prilleltensky and Nelson.

However, this brings us to our ®rst problem with the paper, which is one of agency.To us it is unclear who the authors hope to in¯uence and where they are locatingthemselves. Prilleltensky and Nelson write in the ®rst person plural, but it is not clearwho `we' are. Are `we' academic or practising psychologists, policy makers or politi-cians? Thus, although the authors seem to include themselves amongst those whohave failed to act on knowledge of the wider in¯uences on emotional health, it is notclear how far the blanket of criticism is spread. Certainly there are academics andpractitioners working in community psychology and child health who would arguethat they have been working for decades to address issues of child and family wellnessthrough research and writing, political and community action. We asked: How usefulis this article in e�ecting change? And who could it be useful to? What is the place ofan academic article such as this? Could it be useful to policy makers?

Secondly we asked ourselves how useful the concepts and frameworks are to us aspractising community psychologists. We asked how it adds to or complements the

* Correspondence to: Heather Hunt, Psychological Health She�eld, Fulwood House, Fulwood Road,She�eld, UK.

Commentaries on Prilleltensky and Nelson 117

Copyright # 2000 John Wiley & Sons, Ltd. J. Community Appl. Soc. Psychol., 10: 107±122 (2000)

principles and frameworks community psychologists work from. We are part of theUK Community Psychology Network: academics and public sector employeescontributing to practice and debate about how psychology can address di�erent levelsof in¯uence with di�erent client groups. We share a broad understanding thatcommunity psychology is about understanding people within their social worlds andusing this understanding to improve people's well-being. This entails a continualexamination of how power relations operate, be these economic, coercive or ideo-logical (Orford, 1992). The relevance of developing our understanding of thein¯uence of power on psychological functioning is highlighted in an editorial for thisjournal (Bostock and Smail, 1999). In her position paper on community psychology,Bostock states `Community psychology is concerned with how social environmentsperpetrate psychological su�ering. It can be said to have a social and ecologicalemphasis which draws on an analysis of society in terms of the culturally embeddedoppression of particular groupsÐvia classism, racism and sexism. Psychologicaldistress is seen as arising from a discordant ``®t'' between people and their social andphysical environments, rather than because of intra-psychic causes' (Bostock, 1991,p. 2). Those psychological approaches are valued which work with people's andcommunities' strengths, with a perception that community psychology is not neutralbecause it recognizes that society's resources are not fairly distributed, and that somesocial groups are more valued than others. It claims to serve the interests of the client/consumer, rather than those of the profession or its employees. Developing part-icipatory structures and accountability is therefore part of its concern.

We set out to test the framework for interventions put forward by Prilleltensky andNelson by matching our work and understanding to theirs. The authors use the quitewell-established concepts of the prevention±intervention continuum, identifyingtarget groups which are ùniversal', `selective', or `targeted', which we ®nd usefulconceptually but in practice it is often less clear. The authors use Bronfenbrenner'secological levels as a conceptual tool for analysing the di�erent levels of in¯uence onchild and family wellness, again consistent with a community psychology approach(Orford, 1992). Prilleltensky and Nelson argue that although it is well recognized thatsocial network/community (exosystem) and social/political (macrosystem) character-istics a�ect child and family well-being, ìn apparent disregard for this knowledge,workers continue to focus on counselling, therapy or person-centred prevention as themain vehicles for the promotion of wellness'. It is here that our main di�culty withthe framework begins to emerge and its divergence from community psychologyideas, as Prilleltensky and Nelson apparently see working with an individual asnecessarily focusing on individual or microsystem issues. We could think of a numberof examples where this is not the case, e.g. thinking through with parents of a mixed-race child the e�ects of racism on their well-being.

We found this apparent con¯ation of ìndividual' with ìndividualistic' similarlyconfusing in their discussion of values. The values continuum they use in theiranalysis has individualist principles (concerned primarily with the well-being of theperson) at one end and collectivist principles ( focusing on collective wellness) at theother, with the middle range being conceptualized as the values of respect for diversityand collaboration. The authors then categorize psychological interventions as thosewhich promote individualistic values. Again, we felt that this denied the reality of thecomplexity of much of our work and that of our colleagues elsewhere (Bostock andSmail, 1999). Psychologists can base interventions with individuals or groups on a

118 Commentaries on Prilleltensky and Nelson


much broader value base in ways that help demystify an individual's distress andfacilitate links with self-help, social support and advocacy. We want to make thedistinction that the level of interventionÐindividual, community or politicalÐdoesnot dictate the value. We were also reminded that concerted pressure from individualsand groups can be the main impetus to societal change in a way that forces legislationto follow. For instance, women survivors of domestic violence through the collectivevoice of Women's Aid have brought to public awareness the e�ect of male violence onthe well-being of women and children, or more recently the Lawrence family'sdetermination to reveal racism within the police force, which has brought the termìnstitutionalized racism' into the headlines.

We continued to appraise how Prilleltensky and Nelson applied the values theyarticulated in their framework. We share their criticisms of prevention projects whichare skewed towards person-centred approaches `which neglect the need for socialjustice and a fair distribution of societal resources', but are then surprised that theirframework does not incorporate a gender analysis or any acknowledgement of theimpact of racism on limitations to social justice and access to social power. Gender-blind language distorts social reality. So much of what is talked about as familysupport is in fact focused on women as carers. In addition, families are not neutral sitesfor intervention. This was clearly spelled out in one of our projects. Women revealedthat domestic violence was a big issue in their community a�ecting children'semotional development. Isolation, low self-esteem and fear were inhibiting the womena�ected and their children from seeking help. Research indicates this is a common andserious problem for women and children across cultures and countries (Mullender andMorley, 1994). Prilleltensky and Nelson do note the issue when they report Febbraro'scriticism about the conceptual limitations of home-visiting programmes for high-riskmothers as `perpetuating a system that is socially and economically unequal forwomen, the very conditions which threaten violence towards women and children'.They proceed to advocate community development and advocacy interventions topromote gender equality. Not surprisingly we agree with this, but it is thendisappointing that examples of this good practice are not reviewed. Such goodpractice can be found in Canada (Mullender andMorley, 1994), among other researchand practice reports taking a gender perspective. Such evaluated studies of goodpractice are relevant to themulti-level work we and other community psychologists areengaged with in practice and can be in¯uential with policy makers needing èvidence-based practice' in procuring funding.

Respect for diversity is a value promoted by Prilleltensky and Nelson but neitherracism nor ethnic minorities receive a mention throughout the paper. We considerthat Prilleltensky and Nelson could have put the value for respect for diversity intopractice by seeking out examples of good practice of minority groups developingsupport and community development projects relevant to their communities. Theunequal access to social power and resources experienced by black and minorityethnic groups is a serious phenomenon not limited to the UK. Our family supportstrategy includes èndeavours to meet the needs and aspirations of a multi-culturalcommunity'. To begin to do this we need to support and disseminate models of goodpractice such as the London-based Moyenda project (Hylton, 1997), which aims too�er support, advice and networks for African, Afro-Caribbean and South Asiansand to provide alternative practice and theory to European-centred theories andmethods.



Despite our criticisms of the limitations of the framework, we did ®nd the review ofcommunity-based programmes useful and relevant to current initiatives. The UKgovernment is currently allocating very large amounts of money, but on a short timeframe, to projects targeted at pre-school children and family support in the mostdeprived areas, e.g. `Sure Start'. We are involved in consultation about the pro-gramme delivery. A question for us is how that money can be geared to maximize thebene®t for children concerned, actively engage the communities in informed choicesand not have the end result of blaming the projects, or worse, blaming the families inpoverty for not being able to respond to the programmes. The ®rst She�eld `SureStart' programme is targeted on all families in a small geographical area (800 families)of high socio-economic deprivation, i.e. a universal intervention for an `at risk'population. One million pounds is allocated for three years. This works out at about£40 per family a week. However, neighbouring communities get nothing. The paper'sreview of intervention programmes is supportive of the `Sure Start' approach adoptedlocally. Firstly, MacLeod's meta-analysis indicates that programmes focused at theuniversal level, i.e. whole population, show a larger programme e�ect over time thanthe selective programmes, i.e. targeted at `at risk' families. Secondly, the many studiesindicate that it is the multi-component programmes which are most e�ective, i.e. thoseincorporating community development, job placement and marital counselling aswell as parenting skills training. An evaluative review of the time frame of the projectswould be helpful as we are concerned that the three-year time frame for `Sure Start' isfar too short to enable multi-component programmes rooted in the community to¯ourish and reap results.

Following this more general critique, we attempted to try out the utility ofthe speci®c framework exempli®ed in Tables 1 and 2 with our speci®c interven-tions. We used a school-based project called `Respect' as an example. This is apiece of work focusing on domestic abuse prevention and emotional literacy under-taken in collaboration with a local school. Where was it on the intervention±prevention continuum? Because we are based in a so-called deprived area, the localschool population could be considered to be at risk (selective), but the work wasundertaken there because the sta� were interested. And within the school a wholeclass was targeted (universal) but it was the class of 10- and 11-year-olds, Year 6,that was shortly to be facing the di�cult transition to secondary school (selective).What was the value base? The programme of work, planned and facilitated with theclass teacher, focused on using circle time and drama to address issues of self esteem(individual), expression of feelings (making the private public), respect forothers (diversity), the impact of violence in their lives and sources of help (collec-tive). And what about the ecological levels it addressed? It certainly did address theindividual children, but also their ecological context of family, peer group, teachers,the school community, and the wider community from the local ¯ats to the policeforce and the law. It also addressed other ecological levels directly, by working topromote change within the school community, and at strategic multi-agency level hasbeen an in¯uence in promoting policy and training about domestic abuse and theimpact on children. We are sure that there are many examples of prevention/intervention work that are similarly di�cult to categorize. And we would venture tosuggest that programmes that work across the framework suggested are those morelikely to have positive outcomes just because they address multiple levels and have awide value base.



In summary, we welcome the paper's emphasis on the need for programmesa�ecting family well-being to address the socio-economic contexts of families' livesand that poverty elimination is vital in any serious attempt to limit the harm that isdone to children. However, within our context we were disappointed that we did not®nd the paper more useful. We found the framework proposed by Prilleltensky andNelson somewhat confusing and lacking in an integration of the dynamics of power. Itis here we recognized a divergence with a community psychology perspective. Weshare the authors' values of collaboration and respect for diversity but were dis-appointed that studies reviewed or models developed did not include good-practiceexamples which could challenge the sharp end of racism and sexism that limit the well-being of families in our divided societies. There may be cultural and linguistic issuesthat make the paper less relevant to practitioners in the UK than those in Canada. Itmade us appreciate the context of community psychology work in the UK as com-monly within the public service sector enabling multi-level working and campaigningwhich may be less possible in North America. A social policy colleague shared ourcritique of the unhelpful dualism of the individual versus collective spectrum.Together we are working towards more collaboration between individually focusedand community-based services and between projects and agencies in ways that canlead to a network of accessible and appropriate services relevant to diverse families indiverse communities. We suggest that helpful values are those that are respectful andrelationalÐenabling and connecting for both `clients' and projects, i.e. each playing apart in a bigger picture towards personal well-being and social justice. However, oursocial policy colleague o�ers a salutary warning that in `making the shift from crisisintervention services to prevention, the roller coaster is going the other way in terms ofthe impact of litigation and the increasing use of legal services by individual familieswhich massively drains resources away from prevention to meeting individual needs inan unplanned way'Ðan example of a clash between individualistic and collectivevalues? In this light we welcomed the paper's emphasis on the need for societal andcommunity-focused interventions and welcome those studies which have a long timeframe. In the UK, redressing 18 years of increasing health and wealth inequalitiesneeds a long-term view and long-term funding commitment. It is here that we totallyconcur with the paper's concluding sentence: `We need to resist the pressure to pathol-ogize families and individualize social problems and, instead, we need to reformulatesolutions in terms of parental, communal, and government responsibility.'

ACKNOWLEDGEMENT

We would like to thank Carolyn Leary for her helpful comments from the socialpolicy perspective.

REFERENCES

Bostock J. 1991. Developing a radical approach: the contribution and dangers of communitypsychology. Clinical Psychology Forum, June; 2±6.

Bostock J, Smail D. 1999. Power, the environment and community psychology. Editorial.Journal of Community & Applied Social Psychology, 9: 75±78.



Hylton C. 1997. Black Families Talking: Family Survival Strategies. Thomas Coram Institute:London.

Mullender M, Morley R. 1994. Children Living with Domestic Violence: Putting Men's Abuse ofWomen on the Child Care Agenda. Whiting & Birch: London.

Orford J. 1992. Community Psychology: Theory and Practice. Wiley: Chichester.Wilkinson R. 1996. Unhealthy Societies: The A�ictions of Inequality. Routledge: London.

Editor's Note

Isaac Prilleltensky and Geo�rey Nelson will reply to the Commentaries in the nextissue of the Journal.



commentaries on prilleltensky and nelson

Documents